Ecuador

Clinical Trial Application	Ecuador Clinical Trial Quote Request Ecuador Know Your Customer Form
Mandated Coverage	Yes
Standard Limits	n/a
Tail Coverage	n/a
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in Spanish • Local Legal Representative/CRO details (Contact Person Name, Telephone Number and E-mail Address) and RUC number (Ecuadorian Tax ID) • No refund for policy cancellation - CRO or Local Legal Representative must provide the completed "Know Your Customer Form"

Clinical Trial Application	Bosnia Clinical Trial Quote Request Clinical Trials Quote Request
Mandated Coverage	Unknown
Standard Limits	650,000 USD Per Patient/ 4,000,000 USD Per Trial (if issued by a local insurer)
Tail Coverage	5 years
Data Required to Quote	• Clinical Trial Quote Request • Protocol and Informed Consent Form in English • Protocol Title in Bosnian • Site List in English and Bosnian, inclusive of Full Name(s) of Principal Investigator(s), the Hospital(s)/Site Location(s) Address(es) with Area Code No refund for policy cancellation